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引文資料
題名:
加護病房院內感染指標--影響呼吸器相關肺炎感染因素之探討
書刊名:
臺灣公共衛生雜誌
作者:
吳肖琪
/
陳啟禎
作者(外文):
Wu, Shiao-chi
/
Chen, Chi-chen
出版日期:
2004
卷期:
23:6
頁次:
頁440-446
主題關鍵詞:
呼吸器相關肺炎感染
;
加護病房
;
院內感染
;
Ventilator-associated pneumonia
;
Intensive care unit
;
Nosocomial infection
原始連結:
連回原系統網址
相關次數:
被引用次數:期刊(
1
) 博士論文(0) 專書(0) 專書論文(0)
排除自我引用:
1
共同引用:0
點閱:128
目標:利用全國健保申報住診次級資料,探討加護病房呼吸器相關肺炎(Ventilator-Associated Pneumonia, VAP)感染情形及相關因素。方法:以民國88年健保申報曾住加護病房且使用呼吸器病患為研究對象,以邏輯斯迴歸分析其VAP感染情形與病患特質(性別、年齡、加護病房住院天數及是否患有慢性肺部疾病)及醫院特質(權屬別、評鑑層級、總床數及加護病房床數)間關聯性。結果:在加護病房裝置呼吸器共計申報有76,979人次,其中2,952人次為VAP感染,感染機率為3.83%。在病患特質中,男性(AOR, 1.27; 95% CI,1.17-1.38)、年齡愈大(25-44歲[AOR,1.56;95% CI,1.20-2.02], 45-64歲[AOR,1.86;95% CI, 1.54 - 2.25],65歲以上[AOR,2.72;95% CI,2.28-3.26] )之VAP感染機率顯著較高;加護病房住院天數愈長(3-5天[AOR,1.91;95% CI,1.63-2.24], 6-13天[AOR,4.14;95% CI, 3.61 - 4.76],14天以上 [AOR,7.25;95% CI,6.37-8.29] )與VAP感染機率有關;在醫院特質中,私立(AOR, 1.67; 95% CI,1.51-1.84)、評鑑層級愈低(區域醫院[AOR,2.26;95% CI,2.03-2.51],地區教學醫院[AOR,3.18;95% CI, 2.81-3.61],地區醫院[AOR,5.84;95% CI,5.16-6.60] )之醫院VAP感染機率顯著較高。結論:衛生主管機關可利用健保申報次級資料,監控加護病房VAP感染情形,並針對加護病房VAP感染相關因素,作進一步預防措施。
以文找文
Objective: Using claimed data from National Health Insurance (NHI) to identify factors associated with the development of ventilator-associated pneumonia (VAP). Method: Insured patients, who received mechanical ventilation in the Intensive Care Unit (ICU) in 1999, were analyzed in this study. The relationship among VAP, patients’ characteristics (such as sex, age, history of chronic obstructive pulmonary disease (COPD), and length of stay of ICU) and the characteristics of hospitals (such as ownership, accredited, number of general and ICU beds) were analyzed by logistic regression. Results: There was 2952 of 76979 (3.83%) patients who developed VAP during hospitalization in ICU. The infectious rate of VAP was significantly higher in male (adjusted odds rate (AOR) 1.27, 95% CI 1.17-1.38) and elder patients (AOR of 25-44 years old was 1.56, 95% confidence interval (95% CI) was 1.20-2.02; AOR of 45-64 years old was 1.86, 95% CI was 1.54-2.25; AOR of above 65 years old was 2.72, 95% CI was 2.28-3.26). The rate of VAP was related to the longer length of stay in ICU (AOR of 3-5 days in ICU was 1.91, 95% CI was 1.63-2.24; AOR of 6-13 days in ICU was 4.14, 95% CI was 3.61-4.76; AOR of over 14days in ICU was 7.25, 95%CI was 6.37-8.29). The rate of VAP was higher in private hospitals (AOR 1.67, 95% CI 1.51-1.84). Compared with teaching hospitals, the lower hospital accreditation level was assoicated with a higher rate of VAP (AOR of regional hospitals was 2.26, 95% CI 2.03-2.51; AOR of district teaching hospitals was 3.18, 95% CI 2.81-3.61; AOR of district hospitals was 5.84, 95% CI 5.16-6.60). Conclusion: The claimed data from NHI can be used for monitoring the condition of VAP in ICU patients by the governmental institute in order to construct policy to prevent further VAP.
以文找文
期刊論文
1.
Rello, J.、Ollendorf, D. A.、Oster, G.、Vera-Llonch, M.、Bellm, L.、Redman, R.(2002)。Epidemiology and Outcomes of Ventilator-Associated Pneumonia in a Large US Database。Chest,122(6),2115-2121。
2.
Vincent, J. L.、Bihari, D. J.、Suter, P. M.(1995)。The Prevalence of Nosocomial Infection in Intensive Care Units in Europe. Results of the European Prevalence of Infection in Intensive Care Study. EPIC International Advisory Committee。JAMA: The Journal of the American Medical Association,274,639-644。
3.
George, D. L.(1995)。Epidemiology of Nosocomial Pneumonia in Intensive Care Unit Patients。Clin Chest Med,16,29-44。
4.
Richards, M. J.、Edwards, J. R.、Culver, D. H.、Gaynes, R. P.、NNIS(2000)。Nosocomial Infections in Combined Medical-Surgical Intensive Care Units in the United States。Infection Control and Hospital Epidemiology,21,510-515。
5.
Cook, D. J.、Kollef, M. H.(1998)。Risk Factors for ICU-Acquired Pneumonia。JAMA: The Journal of the American Medical Association,279,1605-1606。
6.
Warren, D. K.、Shukla, S. J.、Olsen, M. A.(2003)。Outcome and Attributable Cost of Ventilator-Associated Pneumonia Among Intensive Care Unit Patients in a Suburban Medical Center。Critical Care Medicine,31,1312-1317。
7.
Kollef, M. H.(1993)。Ventilator-Associated Pneumonia. A Multivariate Analysis。JAMA: The Journal of the American Medical Association,270,1965-1970。
8.
Rubin, R. J.、Harrington, C. A.、Poon, A.、Dietrich, K.、Greene, J. A.、Moiduddin, A.(1999)。The Economic Impact of Staphylococcus Aureus Infection in New York City Hospitals。Emerg Infect Dis,5,9-17。
9.
林金絲、黃忠智、饒淳英、樊美如、葉玉蓉、許詩典(2000)。臺灣北部某地區教學醫院院內感染調查分析。感控雜誌,15,313-325。
延伸查詢
10.
李欣倫、邱月壁、蘇玲慧、黃玉成、呂學重(2002)。臺灣兒童醫院1995-1999年間之院內感染調查分析。感控雜誌,12,69-77。
延伸查詢
11.
Kollef, M. H.、Von Harz, B.、Prentice, D.(1997)。Patient Transport from Intensive Care Increases the Risk of Developing Ventilator-Associated Pneumonia。Chest,112,765-773。
12.
Sofianou, D. C.、Constandinidis, T. C.、Yannacou, M.、Anastasiou, H.、Sofianos, E.(2000)。Analysis of Risk Factors for Ventilator-Associated Pneumonia in a Multidisciplinary Intensive Care Unit。Eur J Clin Microbiol,19,460-463。
13.
Rello, J.、Ausina, V.、Ricart, M.(1994)。Risk Factors for Infection by Pseudomonas Aeruginosa in Patients with Ventilator-Associated Pneumonia。Intens Care Med,20,193-198。
14.
Papazian, L.、Bregeon, F.、Thirion, X.(1996)。Effect of Ventilator-Associated Pneumonia on Mortality and Morbidity。American Journal of Respiratory and Critical Care Medicine,154,91-97。
15.
De Irala-Estevez, J.、Martinez-Concha, D.、Diaz-Molina, C.、Masa-Calles, J.、Serrano Del Castillo, A.、Fernandez-Crehuet Navajas, R.(2001)。Comparison of Different Methodological Approaches to Identify Risk Factors of Nosocomial Infection in Intensive Care Units。Intens Care Med,27,1254-1262。
16.
Hebden, J.(2000)。Use of ICD-9-CM Coding as a Case-Finding Method for Sternal Wound Infections After CABG Procedures。American Journal of Infection Control,28,202-203。
17.
Cadwallader, H. L.、Toohey, M.、Linton, S.、Dyson, A.、Riley, T. V.(2001)。A Comparison of Two Methods for Identifying Surgical Site Infections Following Orthopaedic Surgery。J Hosp Infect,48,261-266。
18.
Kelleghan, S. I.、Salemi, C.、Padilla, S.(1993)。An Effective Continuous Quality Improvement Approach to the Prevention of Ventilator-Associated Pneumonia。American Journal of Infection Control,21,322-330。
圖書
1.
Kleinbaum, D. G.、Kupper, L. L.、Muller, K. E.、Nizam, A.(1998)。Applied Regression Analysis and Other Multivariable Methods。Duxbury Press。
2.
Hosmer, D. W.、Lemeshow, S.(2000)。Applied Logistic Regression。John Wiley & Sons, Inc.。
其他
1.
財團法人醫院評鑑暨醫療品質策進會(2004)。TQIP介紹,沒有紀錄。
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